Posted
by
samzenpus
on Monday January 14, 2013 @06:02PM
from the there-are-no-bad-ideas dept.

Nerval's Lobster writes "Back in 2005, RAND Corporation published an analysis suggesting that hospitals and other health-care facilities could save more than $81 billion a year by adopting electronic health records. While e-records have earned a ton of buzz, the reality hasn't quite worked out: seven years later, RAND's new study suggests that health care providers have largely failed to upgrade their respective IT systems in a way that allows them to take full advantage of e-records. Meanwhile, the health care system in the United States continues to waste hundreds of billions of dollars a year, by some estimates. 'The failure of health information technology to quickly deliver on its promise is not caused by its lack of potential, but rather because of the shortcomings in the design of the IT systems that are currently in place,' Dr. Art Kellerman, senior author of the RAND study, wrote in a Jan. 7 statement. Slow pace of adoption, he added, has further delayed the productivity gains from e-records."

It has been my experience that every health care provider that I have dealt with that offers electronic records, also charges you an "administrative fee" to get a copy of said records at over $1 per page (regardless if it is an electronic document emailed to you).

That administrative fee is just that, administrative, somebody has to go get the document and email it to you. I don't think there's any fully automated secure HIPAA compliant self-retrieval system out there. Charging on a per page level is just an aspect of business and is like one of those $100 to email zutterberg type things to prevent abuse of the system. I'm not exactly quite sure who owns your medical records though, or if there's a free way to get at them, maybe in the non-electronic realm.

I worked for a physician's office, and the doctor has to review the patients chart and sign-off on the record release.
You are paying primarily for the doctor's time to review the chart and the staff's time to prepare the document for the doctor.
There are certain liabilities involved for the physician if there is anything inaccurate in the chart.

They're *about* you, but they're not *yours* because you don't *own* them, the doctor's office and/or hospital does. You must think you live in a nice fantasy land where those who collect data don't somehow own it, the object about which the data references somehow does.

This includes the right to access a copy of the information comprised in their personal data, so you are effectively a joint owner of all data concerning you, except where it runs into one of the exceptions like purposes of national security, crime, taxation, and data held merely domestically.

There are some systems in place for this, we are in the middle of implementing a system called Epic, which does have a portal you can log on and look at your records.

My hope is we move completely away from McKesson, which doesn't offer anything near this, at least on a hospital system, level, they will with a new product on a hospital level, which makes for a bad setup if your system is 8-10 hospitals and a ton of clinics...

There are a ridiculous number of emr systems out there, several with available 3rd party support to manage your IT setup, and some that will offer a VPN or secure citrix environment to work in.

I worked as an intern in IT for a large medical group a couple of years ago, and the consulting firm i work with now does a lot of support for just clinics/doctor offices and the IT aspect alone is expensive. In particular we help them upgrade IT infrastructure in a clinic so they can go live with their central EMR system.

there are workflow assessments to be done, and IT assessments to be done. We charge $95/hour per person, i can spend 3 - 8 hours doing an assessment and documentation for an office. They have staff to do the workflow assessments. We have assessed and rolled out 40+ offices in the last 12 months.

There are PCs to buy (Figure ~1 grand each, though they use thin clients now and again....just not often) and even a small clinic may need 6, a large one may need 30 or even more. Dont forget printers, patients are required to receive after visit summaries from their providers. and a couple of scanners for each clinic.

There is cabling to run...a lot of older buildings have zero cat5/6 wiring so that can be expensive.

there is networking equipment to buy (switches and wireless APs)

there is bandwidth to pay for (most clinics for this group have metro to get them to the main IT office)

there are laptops to buy (often with rolling carts for mobility/convenience)

sometimes we install mounts for the desktops in patient rooms.

there is labor required to image and prep the PCs and laptops, and labor required to roll them out and train the users on the very basic IT concepts they need.

There is training needed to prep users for the EMR system and massive training to get into details and customize the EMR system for a practice or provider.

I don't want to know what the average cost is to take a clinic live with EMR for this group. I know we billed out $300k in IT and cabling services last year, so thats several grand per clinic, minimum, in IT support. nevermind the emr staff and all of the equipment needed. Then the follow up IT support for misc PC issues, misc EMR issues, misc printing issues.

Some clinics already had a 3rd party supported EMR system that got replaced, but they have to keep it available for years. some of them were on their second system before we took them live on the new one...i have no idea how the very first one is supposed to get supported as legally required, but they were told to keep vendor support for anything they can as long as legally required because the medical group cant support anything but their own system.

for some clinics its a nice, welcome change. for some they equate to some level of hell. for everyone clinic there is a pretty serious cost to consider, and a lot of clinics had a very old or limited IT infrastructure to support what they already had.

Plus you switch to one of these systems, too many try to move the paper workflow straight into the PC and force it to work...

People work differently on paper than on a PC, so it should be a different flow, hopefully a better flow.

There are a ton of benefits, but yea, it's pricey. And when you have the internal staff, the person paying the doctor is paying for a large amount of things... you have to pay the office workers, the cleaning people, the building costs, the administrative offices, data center, all

Quality of care is also important. I have a relative with a mental illness. Occassionally they need to be confined to a hospital. Everytime they go in, the hospital doesn't have their records. This means the doctors start from scratch each time. They start off with the same treatment that doesn't work. They then rerun the same tests and experiment to find a treatement that works. 3 or 4 days to get records is a long time. If I call the hospital to speak to my relative my call is forwarded to a nurses station. That station then looks up the patient list on paper and if my relative is not found they forward my call to a different station. After 3 or 4 forwards I get my relative. Some hospitals in the USA are still in the 1980s.

If you have ever supported doctors as end users, you would know that anything that deviates even slightly from their expectation of how it SHOULD work (whether they're right or not, they're right, they're doctors) is too complicated and a lousy system, and they'll refuse to use it.

Doctors and lawyers are two populations of users I really don't want to work with.

I support several small medical practices. They don't (or say they don't) have enough money to upgrade their systems. Like any small business, potential savings in the future don't always translate to extra income now. New systems are expensive and often included monthly fees from the software providers. In addition, if their analog, handwritten system has been working for decades, there's not a lot of incentive to switch.

It's not just that. It's that there are so many different systems out there, and even with standards for treatment and diagnosis codes getting systems to talk to each other can be a major challenge. Frequently, even between different departments in the same hospital, you'll find different systems. You'll see care givers re-entering the same information into each one.

Because the various competing "e-record" systems providers don't WANT an open standard. There is FAR more money to be made in proprietary systems, and expensive "translation layers" to talk to OTHER proprietary systems.

Basically, we don't have e-records because the healthcare system in this country is riddled with greed. Efficiency and quality are NOT a priority, and in fact, are generally DISCOURAGED.

you think standards allow for data exchanges. That is so funny. when every standard is backed by massive patents that are only partially shared.

I look at it this way. it has taken nearly 20 years for software companies to design decent POS software. Even at that there are many on the market today with features that are just plain stupid. Go swipe your debit/credit card at a gas pump, grocery store, etc. how many different button options are available? does it take debit first or cre

My thoughts exactly. I'm currently a medical student on rotation, and have used about five systems from different vendors thus far, all at hospitals and clinics located no more than about an hour and a half drive from each other. Only two of these systems were able to communicate with each other, and not particularly well.

Originally expected to cost Â£2.3 billion (bn) over three years, in June 2006 the total cost was estimated by the National Audit Office to be Â£12.4bn over 10 years, and the NAO also noted that "...it was not demonstrated that the financial value of the benefits exceeds the cost of the Programme"....

I worked for the NHS, then for suppliers serving the NHS, now I work for the NHS again (in the department that used to be the National Programme for IT). The problem is Cathedral mentality. Rather than do something simple that you can expand, everyone wants an all-singing, all-dancing, solves every problem out of the box EHR system.

But everyone wants a system that will conform to the little local quirks - in effect, they want their current system, But With A Computer (tm).

For US readers, it should be pointed out that the British National Health Service is implemented on the ground as a number of regional organisations rather than a single nationwide behemoth. This leads to a lot of variation across the country in quality of care in certain specialities or medical outcomes which the tabloid press gleefully reports on every now and then. It also means record-keeping systems are different so building a one-size-fits-all solution that doesn't break existing ways of doing things

Just so. If there was a standard for medical records storage, as there is for electronic billing for medical services, it would provide a much greater incentive to join the pool. As it is, installing a medical records system from the Mrs. Grace L. Ferguson Medical Records and Storm Door Company (credit: Bob Newhart [youtube.com]) might get your medical practice an electronic records system, but interchange with the hospital you admit your patients to? So sorry, just fax us the hard copy and we'll re-enter the data here.

Our National Programme for IT (in the NHS) was a much-publicised £12B failure.

Can you imagine what could have been achieved if that had been spent properly? We could have instituted a programme producing standard, Free (as in speech) software for solving healthcare IT problems. Even if they'd just shoved £12B into a savings account and made software with the interest, we'd probably have some really kick ass software (and have thrown a lot of dross away in the process o

Whenever I hear the name "VistA" I shudder inwardly. Why? Because it's written in MUMPS [thedailywtf.com]. I mean, FFS, this is a language that has had two articles [thedailywtf.com] all to itself on DailyWTF.

For my sins, I had to do some work on a system written in MUMPS. I guess it's a rite of passage that you just have to endure in the healthcare IT world if you want to graduate to the more wizardly ranks. I had to deal with it for a mere two days. I never want to see another line of MUMPS code again.

Can [VistA] calculate the correct amount of a drug to give an infant vs. an overweight man?

I don't know much about the pediatric capability (or lack thereof) in VistA. But I imagine that there are plenty of fat veterans, especially given the "diabesity" epidemic that's comorbid with "affluenza".

working with IT and ambulatory for a regional medical group the biggest thing ive heard complaints (and responses from the medical group):

your EMR system is not customized to suit our practice type, the one we use it (we will do some customization for you, we MIGHT do a lot)your EMR system does not keep pictures? why? (too much data usage, per IT at the medical group, they are working on a testing group for emergency use)your EMR system kicks me out after 15 minutes of inactivity, this is not convenient (so

--shame IT doesnt test out a couple of other models, or support ANY tablet PCs--- one manager has started to support iPad access to the system on a limited, request only basis. he wants to expand this.

How much of this is due to Apple's review process? To test the software for use with the App Store, an Apple employee needs to be given a functioning user account. Otherwise, the developer is allowed to use only those functions that can be implemented in the subset of HTML5 that Safari implements. Perhaps the "limited, request only basis" means they only have a few provisioning points left on their developer license.

I use it daily and it is not intuitive, not user friendly, has a horribad UI, and not user modifiable.

The biggest problem is that Epic doesn't sell simplicity. They sell parts and each site gets to decide what parts to use. It would be like buying a Ford Explorer but only getting a parts bin and asking a local mechanic to put it together.

There are tons of user screens, small buttons, buttons that use similar na

the medical group i worked with and sometimes consult for uses EPIC. not all of the clinics like it once they move to it, steep learning curve between systems apparently. never heard anyone bitch about the billing aspect, but they have been using it for several years now and are committed to it across 10 hospitals and dozens of clinics. I wasnt around when the main hospitals originally moved to it, so maybe it was something they had to deal with a while back. As it is now...nobody complains and the medical

exactly. It's easy enough for a major HMO in a large city to adopt a new system like this. But in a town of 5000 and a local Doctors office? No way in hell is this cost effective. There's a reason large HMOs don't have offices in towns like that. I think one of the biggest problems we have in this country is that we continue to elect people to office that have never lived in a small town, and have no idea how those towns work. Yet, the majority of this country is made up of small towns.

... help them actually code procedures correctly for insurance, and maybe assemble one whole entire bill without committing at least one major error, and to stop sending me bills that I shouldn't have gotten at all then telling me to just ignore it when I call?

Because not having to call someone—usually more than once—to get the hospital's billing fuckups fixed after a majority of visits would be awesome.

It's been my experience that requiring e-records in the office have actually increased the number of items that get billed. The charges are higher than they have before simply because the physicians must record everything now as a bill-able item. No more freebies from your doctor. They have to itemize every medical issue you ask about now. I support a bunch of offices and it's happening in 100% of the offices. Ironically the doctors hate it because they spend all their time looking at a screen entering

Here's [nytimes.com] an interesting article on how EMRs may be contributing to overbilling. One of the claims it makes is that the ease with which EMRs permit physicians to enter procedures that were not done is a large part of the problem.

I'm contracting in the industry right now, and...
The problem with e-records is draconian HIPAA [aafp.org] requirements. Also all our systems have to be able to pass an audit by the FDA, meaning if I add a piece of javascript to check for numerics... re-validation! I'm not saying the government should back down, medical records need to be private, but they've got IT management and senior staff here trembling at the mention of their existence. Supposedly, it's kept the main production system from being update for the last couple of decades or so simply because nobody wants to take on the responsibility of potentially getting the business shut down... then again that's operations, and they can be a bit dirka dir, but it's definitely a problem from both sides of the fence.

Not all systems require FDA validation, only those classified as 'medical devices', which sadly includes EHR systems. Anything that is used by a doctor to make a treatment decision. You are free to do whatever you like with your Exchange servers.

So... it's EHR systems and systems that use those systems, anything that handles customer data basically... for us that's most of our systems, does it send an email to the customer? regulations! Exchange, active directory, & stuff like terminal services have nothing to do with the EHR whatsoever. I also wonder how close HIPAA requirements came to requiring encrypted emails for EHR data.

At least in my experience it did not cover "second tier" systems like email gateways, even medical data messaging systems (HL7 gateways, e.g.). Microsoft doesn't get FDA validation for Exchange. The FDA rules even allow for security patching and other alterations to the first tier medical devices without re-validation, as long as they weren't designed to alter the medical decision flow. My point is that if your org is interpreting these rules to mean no changes can be made, my experience suggests they migh

So anything a doctor uses to make a treatment decision must be FDA validated. Which also includes the EHR system because the doctor needs to know the medical history as well as any drugs or other things you're taking (your chart is part of the EHR)....

Re: Are you kidding me? The difficulty with HL7....
Problems with HL7? Just wait for the third iteration after HL7 to see it crash and burn... Remember what happened with the last HL10? http://en.wikipedia.org/wiki/HL-10#Fictional_references [wikipedia.org]
We ended up with the
Bionic Man [wikipedia.org]. Hell, if we could do something like that for $6M-USA these days, wouldn't that be amazing?

The dirty secret of healthcare is that you don't need the government for safety. You need consumers to be more vigilant and involved in their own care.

In other words, consumers have to become medical experts, and polymaths at that, when all the best paid doctors are highly specialized.

Bullshit. There's a reason the phrase for people selling something that doesn't work is "snake oil". Healthcare is a complex subject. If it's too complex for a single professional to grasp the entirety of it, what hope do consumers have?

The dirty secret of healthcare is that HMOs exist to deny you treatment, because that's how they make more money, and that they co-opt docto

So who sets the interoperability standard for EMR? Who enforces basic privacy rules (not HIPAA, simpler than that)? Who keeps providers and HMOs from increasing prices just because they can with a captive audience?

Health care is the last industry that we want deregulated. Consumers already get treated like total shit because you have to get your health insurance through your employer (or pay ridiculous premiums yourself). That 'red tape' exists because insurance companies and care providers will get com

I am involved as a consultant to several practices and frankly the software stinks.Buggy, incomplete, error prone, and over priced.If I had a nickel for every time I have been told it will be fixed in the next release I would be a millionaire.I feel sorry for the medical professionals who have to deal with the garbage software on a day to day basis and the consumers who get sub-par service both medical and billing because of it.

One example is:If one thing is billed another is automatically added to the bill because they were often used together.The problem: They are no longer recommended to be used together as a better and cheaper test has replaced one of them.A year and a half later the problem is still in the software and if someone forgets to manually remove it the insurance rejects payment and the patient gets a bogus bill for several hundred dollars.

Yep, most of it stinks. In fact, if you google a bit it's not hard to find studies showing much revenue drs lose in the first year or two of using electronic medical records. That's right, they lose money, because they see fewer patients, because the software slows them down enough to have a material effect on their productivity.

There's a morass of reasons why the software evolved to be so user-hostile--way more than I'd go into for a/. post. But I will say that now federal regulations will prevent any sub

have you worked with Cerner or Epic? both systems allow health care systems to achieve HIMSS level 7 fairly quickly with very little effort.

Well, I guess I know who's a consultant, eh? Yeah, because substituting jargon like "HIMSS Level 7" in place of any meaningful discussion regarding the speed and effectiveness of the software's user interface is just classic consultantese bullshit.

FYI, I have developed a custom--yes that's right a true one-off--EMR for a particular clinical specialty operating in a medical school/hospital environment. We stopped adding paper to charts and creating new paper charts in 2007 (IIRC), scanned and put all the act

Is this a chicken or egg problem? Providers don't switch because the software is overpriced and crappy, and the software is that way because there's no competition, and there's no competition because not enough providers are switching?

Sounds like Linus Torvalds, Apple, and Microsoft need to get in a development war in the healthcare space so we can get some decent software:)

Is this a chicken or egg problem? Providers don't switch because the software is overpriced and crappy, and the software is that way because there's no competition, and there's no competition because not enough providers are switching?

Sounds like Linus Torvalds, Apple, and Microsoft need to get in a development war in the healthcare space so we can get some decent software:)

The products are crappy because the government has forced EHR/EMR on American medical systems, even in many cases where any conceivable benefit is vanishingly small before you count the startup and maintenance costs. The vendors have no incentive to improve product or lower prices because the vast majority of hospital customers are stuck with whatever works with their current back-end system (the part that the hospitals implemented long ago and which few can afford to replace). Clinics want something inexpe

"RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005."

Is due to the fact there's no standardization for medical records from hospital to hospital. To accomplish it we first need to nationalize and unify every hospital in the United States. I use the VA Hospitals as my model. They have electronic record interchange already.

Then you can use best practice to standardize all procedures from actual medical procedure to operational procedure and everything in between. Then once you've nationalized the hospitals, setup several NATIONAL universities that grant M.D.'s and integrate the training.

More than this when I was dealing with a hospital with IT, they had a policy of "nothing critical exists unless it is on paper." Apparently they once had a system crash while trying to get information about medication for a patient, and they stopped using their eRecord system overnight.Blue Screen of Death isn't funny when it could cause an actual death.

So either the server failed, or the data in the database was missing / corrupt. He said crash implying a software bug... rolling back the database: not an option. If they didn't have failover in place that can get into regulations real quick, but sounds like a software bug, not acceptable in a medical system.

Epic and Cerner are the two EHRs that are getting deployed by most health systems in the US...There is already a working exchange on a common data request (not HL7's joke of a data interface) that both of those systems support.

And it isn't just hospitals. Even school system record keeping is all over the place. A friend of mine is head shrink at a school. He laments the database conversion done where they assured him everything would be fine only to find a lot of data just missing.

To the point where they want me to re-engineer their old app and add some functionality to it.

Version 2 : The number one complaint I hear about version 2 is that the extensibility features are abused. Yes, it's a standard that defines a way to make it's messages non-standard, and most people exploit that feature to excess.

It's a fairly simple character-delimited-text protocol. Even so, I've seen implementations screw it up so badly that their HL7 patient admin interface didn't even emit valid HL7 messages.

If want to see a terrible example of electronic document conversion, google e-health ontario. Between government incompetence and contractor dishonesty, we ended up (as a province) spending millions in order to get... nothing.

Hah don't have to pay anything at all. Clearly you've never seen a medical bill. Get real, it's more accurate to say, you don't get to choose whether or not you pay due to insurance, so why is the health establishment going to bother? They make an absolute killing already, they have no interest in risking any of their huge profits on projects that don't have guaranteed measurable yields such as all IT projects; predictability is near none. So they stick with the predictably enormously rising prices they kee

And of course, it's an excellent opportunity to shaft the patients a bit more.

The latest revision to the International Classification of Diseases has had an *explosion* of complexity. Ostensibly this is to make it more accurate. What I suspect it's really for is to make it easier to make an error. Because if you make an error in medical records, your HMO can deny you payment.

I am a physician and operate a small practice. The issue for my practice is simply the cost. To make the switch I will have to invest thousands in IT upgrades, and pay thousands of dollars every year for the privilege of continuing to use the software. Further, if this slows me down to the point that I see one fewer patient per day, it will cost me an additional $10,000+ per year in lost revenue. I'm sure an EMR would streamline things for insurance companies, but my practice will see none of the benefits. I feel I provide high quality care with my current system and I don't believe a different record system will improve that. At the end of the day, switching to an EMR means a huge paycut with no improvement in patient care. I just don't see how that makes sense.

Assuming you are actually a physician (this is the internet, after all), you really haven't looked into the available choices if you think this is the case. There are dozens of Ambulatory EHRs available at reasonable prices (well under the MU payouts). Since you have the good fortune of not being an inpatient care provider, some of these solutions are actually usable.
When you consider training and a need to temporarily reduce patient load to accommodate implementation, it might be at break-even or even

I used to regularly visit an ophthamologist for a chronic eye condition. Every visit the doctor would sketch by hand an image of the irregularities on my retina. Imagine the licensing costs of software and hardware required to do this, vs a plain paper template. Not everyone at RAND is a genius...

When my data is on paper in a doctor's office, I know who can see it... the doctor and anyone I ask him to send to.
Why do you think there is such a manic PUSH for all the digitized records? The cynic in me says it's a Data Mining Goldmine for insurers, advertisers, those stupid background checkers, anything at all.... There is so much money to be made from 3rd party access to our records, it's just disgusting. It's like jackals circling in for a piece of the carcass.
And don't tell me any BS about "congress ensures only people who need to see the info will see it". Not only is all computer security laughable, just wait. Maybe not this congress or the next, or the next, but eventually, some congress will say "we are now allowing access to this information for the good of the children". Then collect all the fees for the use of our private info.
Just wait.

Your information, whether in electronic form or on paper, is already available to health researchers. I just need an informed consent waiver and I can use it for research. If we remove identifiers from it, I can use it and share it freely.
There is currently no difference in privacy laws between electronically stored health information and paper records, so anyone your doctor can send your electronic info to they can also fax your records to. Given that very few health information systems interoperate,

right now there is a huge rush to get EHRs up and running to meet meaningful use. Epic has one of the better EHRs. One of the best features in the patient portal. Super easy to setup and super easy for your patients to grab their data and monitor their test results.

Patient portals are not a selling point. People do not care enough to use them. They sound great to everyone involved, but when the rubber meets the road no one cares. There are exceptions, of course, but in general people care about patient portals about as much as they do about personal health records (which also no one uses).
When was the last time you heard someone say "I was going to go to Dr. X because a friend highly recommended him, but he doesn't have a patient portal so I'm going to Dr. Y."
A

64% of physicians hold no ownership stake in their practice. Which means they either work for a large physician group owned by a corporation or a hospital, or they work in a hospital. The reasons sited in that article are exactly the concerns mentioned in the comments here. Regulations and overhead are too much for the independent physician.

Well, only hospitals or huge groups (sometimes huge groups belonging to hospitals) could afford all the IT investment that is going to be required. Not only that, I think everyone sees how the ACO model is going to reward those who have good relationships with hospitals, and the hospital and the major groups that practice there are all pulling tighter together. Of course, in the end the hospital will swallow the practice as they both fight to stay alive. Solo practitioners or two-man partnerships just becom

My wife is an MD and (relatively speaking) is computer literate. She can touch type and navigate typical desktop machines.

Her clinic converted to EHRs several years ago and she still hasn't reached the level of efficiency she had with paper charts. At this point she's gone back to dictating parts of her chart (via speech recognition) to try to regain some of her lost productivity.

A lot of the problem is that the data is VERY free form. The mundane measurements (height, weight, temp, BP, etc) are easy to insert and digitize, and you can pass it off to another health worker to enter it. The really important information, however, doesn't fit into an established structure.

MDs learn how to collect and document patient status during med school and residency. The details vary from one program to the next. The efficiency of an office visit and its subsequent documentation all depend on how well the EMR flow (and even the number of clicks) fits how the MD does an office visit and/or documents a medical procedure.

The disconnect between habits and automation will continue to affect MDs until we have a generation of experience.

While we are finding that medications, drugs, and various substances in fact are reduced in error rates due to adoption of electronic forms, due to table lookups and the lack of data corruption on transcription, it is not always a panacea.

For data capture of patient histories, especially in medical research, due to the complexity and fallibility of the humans involved - our source data, if you will - we find that paper records sometimes are better at allowing us to capture a more correct record of what is h

You make a fair observation, but, while the free form paper based input method is easier, faster, and potentially clearer, it's also way more difficult to get that information out. So, if the next physician happens to find that one page in the patients stack of 400 documents, then it's probably super useful. But, being able to put a flag in the providers face that the patient has a drug allergy, or that the list of particular symptoms are indicative of rare disease-x which the physician wouldn't normally th

Greed. Pure and simple. That is what has killed electronic medical records.

It's anywhere from $60,000 - $100,000 for an EMR system. And if your EMR of choice doesn't do practice management, you have to spend another $10,000 - $20,000 for that.

The big promise of EMR is data portability. And here's the big secret that no one seems to be talking about: the data *is not portable*.

If I have ABC Company's EMR and you have DEF Company's EMR, I cannot export a patient chart, send it to you and then you import it. You cannot connect to my EMR and get charts for patients I refer to your clinic. So there is no universal patient chart that follows you where ever you go.

Plus, if you *do* have some other electronic system that has to interact with your EMR (say a pathology system or a perscriptions system) you have to pay *both* companies typically $10,000 *each* to do an HL7 link between to two systems. And even then, the link between the systems is spotty at best and half the time doesn't work.

A company that has very little in the way of technology wants to transition to EMR. So they have to spend $30,000 - $40,000 just for the computer hardware (workstations, servers, printers, scanners, routers, switches, etc.) and then another $60,000 - $100,000 for their EMR and practice management needs. THEN, the users have to be trained. I do IT and primarily work with medical offices and sugrical centers. I can tell you that doctors *do not want* to learn how to use computers and software. The office employees fight it, everyone fights it. Eventually they give up and don't use it and let $100,000 worth of hardware and software go to waste because they become too frustrated to use it, it slows them down exponentially and it hasn't made anything easier or more portable. I have seen so many offices basically throw money down the toilet on these EMRs. They get them, and within a month they can't stand them and just go back to paper charts. Not to mention how much they get in the way of patient care. My wife recently went to see the doctor. The doctor was hunched over her computer the whole time and seemed more concerned with making a typo than with paying attention to my wife. Paitent care is suffering greatly.

THEN, the EMR companies want to hold back common sense features and charge you tens of thousands of dollars to implement them. One office I worked with had a web-based EMR and the doctor wanted to be able to recieve faxes right into the EMR. They said sure, you can do that. She asked if they could download and print out the faxes if they needed to. The company told them that yes, they could, but that was an extra feature that would cost $10,000.

Vendor Lock-in is not just something that they strive for, it is the very *core* of the EMR landscape right now.

EMR is a complete and total failure and you can lay that failure squarely at the feet of the greedy bastards who sell it.

My wife recently went to see the doctor. The doctor was hunched over her computer the whole time and seemed more concerned with making a typo than with paying attention to my wife. Paitent care is suffering greatly.

I have to agree, as a medical student I've been rotating through various practices, and EMR systems are causing serious problems with this. Some physicians adapt and find ways to manage both the demands of the EMR system and patient social/psychological interaction, but they only succeed by constantly rebelling against the way that the system is pushing you to work.

From this perspective, the best EMR systems I've seen are the limited ones that don't try to do too much, and allow you to do more talking and

We distribute to 18 countries, but our primary business is in Australia. We do not sell into the US (and don't want to).

In Australia, the government standard for cloud based EMR is 'Patient Controlled'. They call it PCEHR (Patient Controlled Electronic Health Record). We've nicknamed it 'pecker'. In one sense, it is a good idea, as the patient owns their own data and cannot be held to ransom by their health care provider. Arguably, the authorities could never have made the decision for the data to be owned in any other way.

However, it also means that the electronic patient record contains only the data that the patient wishes to include. Any practitioner would be crazy to accept that record as 'complete' - and for the sake of their PI insurance (and the patient's wellbeing), they basically have to disregard the online electronic record and start from scratch every time.

Furthermore, most health care providers value their business based on the IP in their electronic records (more traditionally known as 'Good Will'). They will not willingly give up that information - at least, not quickly.

Sadly, I can't see an easy solution. It will take time and a bucketload of stakeholder engagement by the government - something that most governments are not very good at.

I strongly suspect (having worked in IT but not in a health care setting) that part of the problem with getting EMR systems implemented is that most doctor's offices/hospitals would sooner rip their own arms off than adequately fund IT for their organization. If these IT departments were 1) staffed sufficiently to sanely handle the workload (they never are) and 2) trusted to know what they're doing, things would improve. Doctors and nurses push back a lot on new systems, and I think part of the problem th

The doctors I've met and worked for felt that they were getting jacked around by EMR vendors. One of the biggest promised features for 2012 that won't be added until the 2013 version, requiring double the cost that was originally quoted. And since the feds have kept pushing back the dates for some EMR requirements, many practices are taking a wait-and-see approach. Also, billing is often done through aggregators who will accept older versions of billing software submissions; this means practices don't have to implement the latest and greatest, sometimes saving tens of thousands of dollars and all the hassle that comes from having a workforce who doesn't know how to operate the new version of the EMR.